Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 111111 | MA |
NPI | 1700012689 |
---|---|
Provider Name | Dr. Larry Zhao |
First Address | Indianapolis, IN 46260-1987 |
Second Address | Pikeville, KY 41501-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2009 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100358540 | (05) | KY |